Viewpoint

You aren’t the boss of me!

FROM THE CHIEF MEDICAL EDITOR

Larry E. Patterson, MD

In the darkened lecture hall, hundreds of surgeons listened as the retinal specialist waxed eloquent about the complexity of intravitreal injections. He concluded adamantly that only fellowship-trained retinal surgeons should be involved in such treatments and that the general ophthalmologist should stay far away from the retina. The generalist simply could not master the intricacies of such diseases like AMD, CRVO, BRVO, DME.

Hey, no problem; I’ve heard this before. Everyone’s entitled to his opinion. It was only later in the same presentation when the same speaker forced the writing of this month’s Viewpoint. He described situations in retinal surgery in which the specialist needed to consider simultaneous cataract removal. He said in that situation it was okay for the retinal specialist to perform cataract surgery, as long as he was properly trained and proficient to do so.

So, it is okay for a retinal specialist to master the complexities of phaco-emulsification, aberrometry, topography, optical coherence biometry and/or immersion ultrasound, new complex IOL calculations and IOL selection — but it’s not okay for the cataract surgeon to learn the complexities of medical retinal care.

I bring this silly, hypocritical incident up to say this: Everyone, please stop telling everyone else what he or she can, and cannot, do.

I know both retinal and pediatric ophthalmologists who routinely perform fine cataract surgeries. As long as they maintain their art, I have no business telling them they shouldn’t. General ophthalmologists have told me they would not do intravitreal injections because if an adverse incident occurred, they would be questioned as to why they didn’t send the patient to a more experienced physician. Well, wouldn’t that apply to other situations? If you are a new surgeon in a large city, isn’t it likely several surgeons live there who are more competent than you? Won’t there almost always be someone you could have referred your patient to who has more training, expertise, experience? Must only the glaucoma specialist do trabeculectomies or the corneal surgeon perform LASIK?

With the exception of a superman surgeon, it’s not likely one surgeon can competently perform every ophthalmic procedure available. But by the time a person becomes a full-fledged physician, we should be able to make some assumptions. That he, like us, took the Hippocratic oath and swore to uphold specific ethical standards. That he, like us, can make good judgments regarding his abilities and limitations while caring for patients.

Can’t we assume that baseline levels of common sense and good judgment exist for good doctors? For that retinal surgeon, the answer was no. OM